Liver biopsy remains the gold standard in the assessment of severity of liver disease.
Noninvasive tests have gained popularity to predict histology in view of the associated
risks of biopsy. However, many models include tests not readily available, and there
are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed
to develop a model using routine tests to predict liver fibrosis in patients with
HIV/HCV coinfection. A retrospective analysis of liver histology was performed in
832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized
as 0-1, 2-3, or 4-6 and were randomly assigned to training (n = 555) or validation
(n = 277) sets. Multivariate logistic regression analysis revealed that platelet count
(PLT), age, AST, and INR were significantly associated with fibrosis. Additional analysis
revealed PLT, age, AST, and ALT as an alternative model. Based on this, a simple index
(FIB-4) was developed: age ([yr] x AST [U/L]) / ((PLT [10(9)/L]) x (ALT [U/L])(1/2)).
The AUROC of the index was 0.765 for differentiation between Ishak stage 0-3 and 4-6.
At a cutoff of <1.45 in the validation set, the negative predictive value to exclude
advanced fibrosis (stage 4-6) was 90% with a sensitivity of 70%. A cutoff of >3.25
had a positive predictive value of 65% and a specificity of 97%. Using these cutoffs,
87% of the 198 patients with FIB-4 values outside 1.45-3.25 would be correctly classified,
and liver biopsy could be avoided in 71% of the validation group. In conclusion, noninvasive
tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy
in the majority of HIV/HCV-coinfected patients.